Provider Demographics
NPI:1154459840
Name:RUSH, PATRICIA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:RUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8645 MIROBALLI DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1062
Mailing Address - Country:US
Mailing Address - Phone:708-218-2914
Mailing Address - Fax:708-218-2914
Practice Address - Street 1:8645 MIROBALLI DR
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1062
Practice Address - Country:US
Practice Address - Phone:708-218-2914
Practice Address - Fax:708-218-2914
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-058235207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24375Medicare UPIN